Admissions Application

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information about you except when we have your permission.


SELECT A PROGRAM Programs: Check Times: AM PM
PERSONAL HISTORY
First Name
M.I.
Last Name

Address Line 1
Address Line 2

City
State
Zip Code


E-mail Address
Phone
Cell Phone


Age
Maiden Name
Date of Birth


Marital Status
Explain


Number of Children
Ages of Children

Physical Problems
IN CASE OF EMERGENCY
Name
Address


Home Phone
Business Phone
Other

EDUCATION COMPLETED
Education Completed
Name of High School

Last grade completed in High School?
Actual/Expected Completion Date

College

Years Attended
Degree

STUDENT EMPLOYER INFORMATION
Present Employer
Phone

PARENT OR GUARDIAN INFORMATION
(IF UNDER 21 YRS)
Parent/Guardian Name
Occupation


Parent/Guardian Address
Phone

Parent/Guardian Employer

Employer's Address
Employer's Phone

SELF EVALUATION
Are you satisfied with your existing job?

No, there is no future
No, it does not pay well
Yes
What has held you back from furthering your your career in the past?
Money
Spouse/Family
Lack of confidence
Lack of education
Lack of time
What motivates you?

Money
Self-esteem
Promotion/recognition
Excitement
Happiness
How do you rate yourself?

A mature person
Still room to mature
Lack responsibility
When it comes to responsibility, I normally:

Enjoy assuming it
Would rather share it
Have trouble assuming it
When I run into a problem, I:

Ask questions
Figure it out
Have trouble assuming it
I would rate my level of commitment to school as:

None
Slightly
Moderately
Extremely
What kind of support do you have at home?

I am encouraged
I am discouraged
Indifferent
Does not pertain to me
How long have you been considering a career in this particular field?

Less than a month
One year or less
Several years
In school, what were your favorite subjects?
List three characteristics that make you valuable in the job market:
Where would you see yourself one year from now?
What situation might arise that would make attending classes difficult?
When was your last accomplishment that made you feel good?

1-800-695-5550

EARTH CITY CAMPUS
4260 Shoreline Drive
Earth City, MO 63045
314.344.4440

KIRKWOOD CAMPUS
10910 Manchester Road
Kirkwood, MO 63122
314.965.8363